Treatment options for Psoriatic Arthritis

Last time we chatted about arthritis, I was talking about the difference between Osteoarthritis (OA) and Psoriatic Arthritis (PsA). Today I wanted to talk about the different treatments for OA and PsA, focusing mostly on those for PsA. While there is some overlap, there is a very distinct difference in the supposed effects of them.

With OA, treatment is generally anti-inflammatory medications. They are used to decrease the inflammation of the joints and, generally speaking, do a good job. With PsA, you take a variety of medications to treat the pain, and other effects of the autoimmune disease.

Treatment options for Psoriatic Arthritis

There are a variety of anti-inflammatory medications on the market, often NSAIDs (non-steroidal anti-inflammatory drugs). From over the counter Ibuprofen to those available by prescription, you can find a vast amount of medication available. Your physician will likely try different ones throughout the course of your disease, whether it be OA or PsA. Many of these medications are taken multiple times a day. Side effects may include stomach irritation, heart problems, and liver and kidney damage.

I also have pain medication if needed, as do many people with arthritis of any kind. I caution everyone to be careful about pain medications. I really struggle with this myself because I don’t want to take an addictive medication to treat something that will never go away. That, to me, seems like a losing battle. Besides, there really is no guarantee that the pain medication will actually take away the pain. It doesn’t always work.

Another class of drugs used for PsA are called DMARDs (Disease-modifying anti rheumatic drugs). The purpose of these medications are to slow the progression of the PsA and to save the joints and tissue from permanent damage. The most common of these are methotrexate (Trexall), leflunomide (Arava), and sulfasalazine (Azulfidine). I, personally, take 2 of these right now. Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Tumor necrosis factor-alpha (TNF-alpha) is an inflammatory substance produced by your body. TNF-alpha inhibitors can help reduce pain, morning stiffness, and tender or swollen joints. This class of drugs is very expensive and many insurances deny them (my insurance made me wait several months before approving usage). Medications in this class include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) and certolizumab (Cimzia). You may need to try different ones as time goes on or simply because one does not work for you. I took Cimzia and it did not help me at all. Enbrel helped but not much. I am currently on Humira and am having some problems but it is better for a week or so between doses. Potential side effects include nausea, diarrhea, hair loss and an increased risk of serious infections. I can attest to extreme fatigue as well.

Finally, you may be given Immunosuppressants such as azathioprine (Imuran, Azasan) and cyclosporine (Gengraf, Neoral, Sandimmune) if your immune system is completely out of control. This is not an option that has been offered to me, nor one my physician uses. It is dangerous to take any of the PsA medications, but these, by far, are the most dangerous to your body. They make you very susceptible to infection.

So, what exactly do I take for my PsA? I take an anti-inflammatory twice a day. I use an injection (Humira) twice a month to lessen inflammation by interfering with biologic substances that cause or worsen inflammation. These are important because my immune system actually attacks my body. I take two DMARDs, Arava and Methotrexate. Did you know that Methotrexate is actually a chemotherapy agent?? As you can imagine, that means that I have a very suppressed immune system so I can (and do) get ill very easily. The trade off is that (hopefully), I will have less pain. There are days that I still need to take pain medication that I hate so much. But, with 3 kids, there is only so much I can handle before going to them.

I hope this helps you understand the medications that those with OA and PsA take. Every one of these comes at a price. As I mentioned, anti-inflammatory medications can be inexpensive. But, when you start getting into different classes of medications, you start getting to higher costs. My injections cost over $3,500.00 a month. That is not including the 3 other medications I take monthly for the PsA. There are ways to get help with medications sometimes. I was getting assistance through the manufacturer for the infections and my insurance did cover some of the cost of the other medications. It isn’t cheap though… and I am now unable to pay for it. I am going to miss my Humira this week so I will be hoping for the best and talking to my doctor next week for future plans. It is worth checking out the help though because the the possibility of not being in pain everyday or dealing with flare-ups is so enticing. My situation is difficult but yours may not be.

I will talk more about other treatment options next time.